When we think of someone with an eating disorder, we usually picture a young, visibly thin female. However, for many dealing with issues around food, this couldn’t be further from the truth.
In Australia, 1.1 million people will experience an eating disorder in any given year. Of those, it’s estimated that 17.6 per cent are aged between 35 and 54. And a growing cohort of women are developing eating disorders later in life.
When a woman hits perimenopause and menopause, it generally coincides with other major life events such as divorce, the death of a parent, an empty nest, unanticipated health challenges and an ageing body.
“These are periods of vulnerability and can be confronting,” says Sarah Cox, psychologist and manager of the Butterfly Foundation’s National Helpline. “Alongside hormonal changes, there’s also societal pressure to maintain that young, thin ideal when your body is changing.”
The early signs
It’s difficult to estimate how many people struggle with mid-life eating disorders. However, one study suggests close to 5 per cent of women aged over 45 are currently living with an eating disorder, many of whom experienced the onset of symptoms in their adolescence.
This was the case for Elysa Roberts, who developed bulimia in her early 20s. While she sought help, she lived with it privately until she was 45, when she restarted the recovery process. Working as an occupational therapist, she managed to hide her eating disorder from family and friends, but after decades of secrecy, it was taxing.
“Eating disorders hijack your ability to participate in daily life,” she says. “They affect your capacity to do your job and be in relationships. Even getting dressed is difficult. I wanted to fully participate again.”
Elysa says she’d internalised diet culture messaging to the point she’d normalised her behaviour in a bid to keep up with society’s impossible beauty standards. “I grew up when it was normal to not like your body. My eating disorder was like a doubling down on diet culture. I did all the things I could to achieve thinness.”
This was reaffirmed by people praising her body and asking what her secret was. This only added to the shame she had around seeking support.
Beyond anorexia and bulimia
One of the biggest misconceptions, explains Sarah, is that you can tell if someone has an eating disorder just by looking at them.
“Eating disorders don’t discriminate. They occur in people of any age, weight, size, shape, gender, sexual orientation, cultural background or socio-economic status.”
And it’s not just the better-known disorders of anorexia nervosa and bulimia. For those aged between 35 and 44, it’s estimated that unspecified feeding or eating disorder (UFED) is the most common, followed by binge eating disorder. UFED refers to disordered behaviour which causes significant distress but does not meet the full criteria for any of the other categories. For those aged between 45 and 54, binge eating disorder is the most common.
“There can be so much shame and stigma around disordered eating,” says Sarah. “A lot of people suffer in silence and may not even recognise they have a diagnosable eating disorder.”
The rising rates of binge eating disorder in older women come as no surprise when you consider the pressures many are under when they hit midlife. Often they see themselves falling to the bottom of a long list of priorities.
Having children or grandchildren to care for, as well as ageing parents and a full-time job, leaves little time for planning regular, healthy meals.
“When you’re juggling all of these balls you miss meals, scarf down an energy bar, and stop recognising your body’s hunger and satiety cues,” says Cynthia Bulik, PhD, Founding Director of the University of North Carolina at Chapel Hill Center of Excellence for Eating Disorders.
“Many are so busy that they’re not eating much at all until their body screams out later in the day that they’re starving. That can be the trigger that drives people to high-fat, high-sugar food, and eating rapidly to address that empty feeling, which is the beginning of a binge pattern.”
The perfect perimenopause storm
For Sue Cody, 55, it was entering perimenopause at the same time her daughter was leaving home which triggered a relapse.
“I developed bulimia in my early 20s. That stuck with me until I was about 30 when I got pregnant and then it went into the background for quite a while. When my daughter left home to go to university I discovered I was in perimenopause, which was something I’d never heard of, and my eating disorder flared up again.”
Senior clinical psychologist and eating disorders expert Associate Professor Gemma Sharp, from Monash University’s School of Translational Medicine, says navigating eating disorders during this time is particularly tough.
“The hormonal fluctuations of menopause can trigger or intensify symptoms, and some women are experiencing their eating disorder return for the first time in decades,” she explains. “Yet women face great uncertainty from health professionals over what’s causing their symptoms, and this affects their ability to manage them.”
To help people self-advocate, Associate Professor Sharp co-designed an online course with Eating Disorders Victoria aimed at women experiencing eating disorders, those supporting a loved one through menopause, and health professionals.
“A lot of people suffer in silence and may not even recognise they have a diagnosable eating disorder.”
Sarah Cox, psychologist
“GPs need information to help meet the challenges of identifying and managing eating disorder fluctuations during the menopausal transition, especially as existing resources on eating disorders generally focus on treating teenagers and young adults,” she explains.
Even when invisible to others, they take a physical toll. The mortality rate for people with eating disorders is the highest of all psychiatric illnesses, and over 12 times higher than that for people without eating disorders. They affect every bodily system and when you’re in midlife, that damage is on top of natural age-related decline.
“Eating disorders wreak havoc on our bodies,” explains Dr Bulik. “An older person can develop more gastrointestinal, cardiovascular, dermatologic, and even dental problems than a younger patient would.”
This has been a reality for Sue, who says her bulimia has had an ongoing impact on her health. “I had a fall a couple of weeks ago and broke three ribs because the eating disorder over the years has weakened my bones.”
Seeking help
When Elysa reached out to a support group for bulimia she realised other accomplished, mature-aged women were experiencing the same thing. “That step helped me realise I wasn’t the only one and mitigated my shame.”
From there she sought the help of a mental-health professional.
“I am in what I refer to as strong recovery,” says Elysa, who will be turning 56 in October.
Stereotypes, says Dr Bulik, are a major barrier to people seeking help.
“There’s shame associated due to decades of blaming sufferers and thinking they’re choices or related to vanity. We should be able to walk into a doctor’s office and say, ‘I think I have an eating disorder, I need help’ without fear of blame or disbelief.”
Sarah says that early intervention is key, and your GP is still the best first port of call to find out what treatment options are available. “Recovery is always possible. It doesn’t mean it’s easy, but it’s always possible.”
Disordered eating: Spot the signs
Whether you think you – or someone you care about – might need support, these are some of the most common symptoms to look out for:
- Rapid weight loss or frequent weight changes.
- Preoccupation with eating, food, body shape and weight.
- Feeling anxious and or irritable around meal times.
- Eating in private and avoiding meals with other people.
- Compulsive or excessive exercising.
- Obsessive rituals around food preparation and eating.
If you need help call Butterfly’s National Helpline, 1800 334 673; Lifeline, 13 11 14; or Beyond Blue, 1300 224 636.
This article originally appeared in the August 2024 issue of The Australian Women’s Weekly. Pick up the latest issue from your local newsagent, or subscribe so you never miss an issue.
